Methods and uses of slit for treating fibrosis

ABSTRACT

The present disclosure provides methods and uses of Slit protein and nucleic acid for inhibiting fibrosis and fibrotic-related disorders, for example, of the kidney, lung, heart, liver, or a wound. The Slit protein can be, for example, Slit 2  or Slit 2 -N, or a Slit variant that can bind the Robo receptor and induce signalling. Also provided are pharmaceutical compositions comprising the Slit protein or nucleic acid and an additional anti-fibrotic agent.

RELATED APPLICATION

This application claims the benefit of priority to U.S. Provisionalapplication No. 61/831,064 filed Jun. 4, 2013, the contents of which areincorporated herein by reference in their entirety.

FIELD

The present disclosure relates to methods and uses for inhibitingfibrosis and for treating associated conditions and diseases comprisingadministering a Slit protein or nucleic acid. The disclosure alsorelates to pharmaceutical compositions comprising Slit protein or anucleic acid thereof and an anti-fibrotic agent.

BACKGROUND

Conventional wisdom predicted that the majority of previously healthypatients who developed acute kidney injury (AKI) would recover withoutsignificant renal sequelae. However, recent large studies indicate thateven healthy patients are at significant risk of developing chronickidney disease (CKD) and end-stage renal disease (ESRD) after oneepisode of AKI (Chawla et al., 2011; Lo et al., 2009; Amdur et al.,2009; Wald et al., 2009; Chawla and Kimmel, 2012). An Ontario studyexamined over 41,000 patients who survived an episode of AKI withoutrequiring acute dialysis at the time of the AKI (Wald et al., 2012).Compared to matched control patients, the patients with AKI had a near3-fold increase in late ESRD necessitating chronic dialysis (Wald etal., 2012). Thus, even a single episode of what would previously havebeen regarded as “mild” AKI sets the stage for later CKD and ESRD.

Ischemia-reperfusion-injury (IRI) is a cause of AKI and may progress toCKD (also known as chronic renal injury) as a result of progressiverenal fibrosis, in which normal elements of the renal tubulointerstitiumare replaced by myofibroblasts that secrete collagenous extracellularmatrix (Bonventre and Yang, 2011; Quaggin and Kapus, 2011; Venkatachalamet al., 2010). The main features include recruitment and proliferationof myofibroblasts which secrete collagenous extracellular matrix, andloss of capillary density (Zeisberg and Neilson, 2010). Eventually, thenormal tubular and vascular structures of the renal interstitium undergoatrophy and become replaced by fibrous scar. Once recruited to thetubulointerstitium, pericytes become myofibroblasts. In response tolocally produced fibrogenic cytokines and growth factors, especiallytransforming growth factor beta (TGF-β), myofibroblasts proliferate andsecrete abundant quantities of extracellular matrix proteins,particularly collagen type I and fibronectin (Kida and Duffield, 2011;Schrimpf and Duffield, 2011; Lin et al., 2011). The net result isreplacement of functional nephrons by scar tissue and progressive kidneyfailure.

Diabetes is the leading cause of chronic kidney disease in mostcountries around the world [Rossing 2006]. In the United States alone,it is estimated that nearly $17 billion is spent annually on diabeticnephropathy care [Gordois et al. 2004]. While glycemic control [DiabetesControl and Complications Trial Research Group 1993, UKPDS 1998], bloodpressure regulation [Adler et al. 2000], and renin-angiotensin systemblockade [Lewis et al. 2001; Brenner et al. 2001; Lewis et al. 1993]slow nephropathy progression, many patients still progress to kidneyfailure, a costly and life-threatening condition requiring renalreplacement therapy. New treatments are clearly needed.

Diabetic nephropathy is driven by a complex set of inter-relatedpathways. Early on, diabetes is commonly characterized byhyperfiltration, a phenomenon that has been linked epidemiologically[Costacou et al. 2009, Magee et al. 2009; Ruggenenti et al. 2012] andmechanistically [Anderson et al. 1986] to poor long-term renal outcomes.While classically felt to be driven by altered renal hemodynamics[Anderson et al. 1993, Sochet et al. 2006], emerging evidence suggeststhat glomerular angiogenesis also augments GFR through increases infiltration surface area created by nascent capillaries [Osterby et al.1988, Hirose et al. 1980]. Later, diabetic nephropathy is characterizedby fibrosis, a largely irreversible process that obliterates bothglomeruli and the tubulointerstitium [Gilbert et al. 1999]. Transforminggrowth factor-β (TGF-β) is a central driver of diabetic fibrogenesis,activating a variety of pro-fibrotic signaling pathways. In particular,two TGF-β signaling intermediates, the Receptor Smads (Smad2 and Smad3)and RhoA, mediate fibrogenesis via both independent and inter-relatedmechanisms [Engel et al. 1999; Bhowmick et al. 2001]. While anti-TGF-βtherapies may block fibrosis, they also inhibit other criticalnon-fibrogenic TGF-β effects, including its potent immunosuppressiveactivity. Thus, anti-TGF-β blockade has been a largely unsuccessfultreatment strategy for diabetic nephropathy.

The Slit family of proteins, together with their transmembrane receptor,Roundabout (Robo), were initially shown to repel axons and neuronalmigration during development of the central nervous system (CNS) (Broseet al., 1999; Kidd et al., 1999). There are three known mammalian Slitfamily members. Slit1 is predominantly expressed in the CNS, while Slit2and, to a lesser degree, Slit3 are expressed in other tissues,especially kidney, heart, and lung (Wu et al., 2001). Slit proteinexpression persists into adulthood, suggesting roles beyond those duringdevelopment. Slit proteins are structurally unique, having bothepidermal-like growth factor and leucine-rich repeats (LRR). Thesefeatures allow secreted Slit to interact with varied proteins, includingcell surface receptors and extracellular matrix proteins such asglypican-1 (Ronca et al., 2001). Thus, Slit can act as a local,non-diffusible signaling molecule. Proteolytic cleavage of Slit2,perhaps by metalloproteases, generates N- and C-terminal fragments(Slit-N and Slit-C) (Brose et al., 1999; Schimmelpfeng et al., 2001;Wang et al., 1999). Slit2-N is sufficient to engage its receptor and toinduce signaling (Nguyen et al., 2001; Battye et al., 2001; Chen et al.,2001).

Robo is a single-pass type 1 transmembrane protein. The extracellularregion contains five immunoglobulin (Ig)-like domains and threefibronectin type III repeats while the intracellular domain containsfour conserved cytoplasmic motifs (CC0, CC1, CC2, and CC3). Theextracellular Ig-like domains of Robo are sufficient for binding the LRRof Slit. The intracellular CC3 motif is necessary for the repulsiveresponse to Slit. Mammals have four Robo isoforms, of which Robo-1 ismost widely expressed in non-neural cells, especially immune cells (Wuet al., 2001; Prasad et al., 2007; Tole et al., 2009).

After Slit2 binds to the extracellular domain of Robo-1, theintracellular domain of Robo-1 associates with a novel family of GTPaseactivating proteins (GAPs), namely Slit-Robo GAPs (srGAP) (Wong et al.,2001). By preventing activation of Cdc42, Slit2 inhibited migration ofcells from the anterior subventricular zone of the forebrain ((Wong etal., 2001). Recent studies examined the effects of Slit2 on migration ofvascular smooth muscle cells (VSMC), lymphocytes, and neutrophilstowards platelet-derived growth factor B (PDGF), the chemokine CXCL12,and formyl-methionyl-leucyl-phenylalanine (fMLP), respectively (Prasadet al., 2007; Tole et al., 2009; Liu et al., 2006). Thesechemoattractants induce cell migration by activating Rac, Cdc42, and/orRho, crucial for reorganization of the cytoskeleton. Slit2 inhibitedactivation of Rac, Cdc42 and/or Rho, and consequent migration of VSMC,lymphocytes, and neutrophils (Prasad et al., 2007; Tole et al., 2009;Liu et al., 2006). The present inventors and others also showed thatSlit2 inhibits migration of leukocytes and cancer cells, and inhibitsplatelet adhesion by preventing activation of Akt and Erk MAPK (Patel etal., 2012; Prasad et al., 2007; Tole et al., 2009; Prasad et al., 2004).

During kidney development Slit and Robo signaling restrict inappropriatemigration of cells (Piper et al., 2000; Grieshammer et al., 2004; Yu etal., 2004). In fact, mutant mice lacking Slit2 do not develop a singleureteric bud, but rather, supernumerary ureteric buds that remainabnormally connected to the nephric duct (Grieshammer et al., 2004).

In adult rodent and human kidneys, Slit2 is expressed by many celltypes, including vascular endothelial cells, glomerular endothelial,mesangial and epithelial cells, and tubular epithelial cells (Wu et al.,2001; Kanellis et al., 2004). In an animal model of crescenticglomerulonephritis, endogenous glomerular expression of Slit2 sharplydecreased, promoting enhanced inflammation (Kanellis et al., 2004). WhenSlit2 was administered systemically in this short-term inflammatorymodel, renal function and renal histology improved significantly(Kanellis et al., 2004).

In U.S. Pat. No. 8,399,404, it was shown that, in a mouse model of IRIin which both renal pedicles are clamped, Slit2 and Slit2-N were shownto prevent renal failure due to acute kidney injury.

Chronic fibrosis after acute or repeated injury is not unique to thekidney, and results in conditions such as chronic obstructive lungdisease, cardiomyopathy and heart failure, and liver cirrhosis. In allof these disorders, fibroblast activation occurs and the normal tissuebecomes irreversibly replaced by fibrotic scar tissue.

SUMMARY

The present inventors have shown that Roundabout (Robo) receptors areexpressed on fibroblasts and have further shown that Slit2, which bindsthe Robo receptor, improves kidney function and inhibits collagendeposition and fibrosis in models of chronic kidney disease.

Accordingly, in one aspect, the present disclosure provides a method ofinhibiting fibrosis comprising administering a Slit protein or nucleicacid to a cell or animal in need thereof. Also provided is use of a Slitprotein or nucleic acid for inhibiting fibrosis in a cell or animal inneed thereof. Further provided is use of a Slit protein or nucleic acidin the manufacture of a medicament for inhibiting fibrosis in a cell oranimal in need thereof. Also provided is a Slit protein or nucleic acidfor use in inhibiting fibrosis in a cell or animal in need thereof.

In one embodiment, the fibrosis is due to the accumulation ofextracellular matrix, such as collagen or fibrinogen.

In one embodiment, the fibrosis is kidney fibrosis, lung fibrosis,cardiac fibrosis, liver fibrosis or excessive fibrosis deposited due toa wound. In a particular embodiment, the fibrosis is kidney fibrosis.

In another aspect, the present disclosure provides a method of treatinga fibrotic-related disorder, condition or disease comprisingadministering a Slit protein or nucleic acid to a cell or animal in needthereof. Also provided is use of a Slit protein or nucleic acid fortreating a fibrotic-related disorder, condition or disease in a cell oranimal in need thereof.

Further provided is use of a Slit protein or nucleic acid in themanufacture of a medicament for treating a fibrotic-related disorder,condition or disease in a cell or animal in need thereof. Even furtherprovided is a Slit protein or nucleic acid for use in treating afibrotic-related disorder, condition or disease in a cell or animal inneed thereof.

In an embodiment, the fibrotic-related disorder, condition or disease isglomerulonephritis, diabetic nephropathy, lupus nephritis, toxicnephropathy, chronic pyelonephritis, polycystic kidney disease, renalscarring, wound scarring, post-cardiac infarction, cystic fibrosis,idiopathic pulmonary fibrosis, cirrhosis, chronic obstructive pulmonarydisease, cardiomyopathy, or all other progressive diseases marked byfibrosis. In a particular embodiment, the fibrotic-related disorder isdiabetic nephropathy.

In some embodiments of the methods and uses disclosed herein, the Slitprotein or nucleic acid is administered or used locally. In someembodiments, the Slit protein or nucleic acid is administered or usedchronically or long-term. In some embodiments, the Slit protein ornucleic acid is administered or used daily, weekly or monthly.

In another aspect, the present disclosure provides a method of treatingchronic kidney disease comprising administering a Slit protein ornucleic acid to a cell or animal in need thereof. Also provided is useof a Slit protein or nucleic acid for treating chronic kidney disease ina cell or animal in need thereof. Further provided is use of a Slitprotein or nucleic acid in the manufacture of a medicament for treatingchronic kidney disease in a cell or animal in need thereof. Even furtherprovided is a Slit protein or nucleic acid for use in treating chronickidney disease in a cell or animal in need thereof.

In one embodiment, the Slit protein or nucleic acid is administered 5days after acute kidney injury, or later. In another embodiment, theSlit protein or nucleic acid is administered 10 days after acute kidneyinjury, or later. In yet another embodiment, the Slit protein or nucleicacid is administered or used 14 days, 1 month, or 6 months after acutekidney injury, or later.

In an embodiment, the subject with chronic kidney disease has aglomerular filtration rate of less than 60 ml/min/1.73 m². In anotherembodiment, the subject with chronic kidney disease is at stage 3 orgreater CKD.

In yet another aspect, the present disclosure provides a method ofprophylactically treating a subject at risk of fibrosis comprisingadministering a Slit protein or nucleic acid to the cell or animal inneed thereof. Also provided is use of a Slit protein or nucleic acid forprophylactically treating subject at risk of fibrosis in a cell oranimal in need thereof. Further provided is use of a Slit protein ornucleic acid in the manufacture of a medicament for prophylacticallytreating subject at risk of fibrosis in a cell or animal in needthereof. Even further provided is a Slit protein or nucleic acid for usein prophylactically treating subject at risk of fibrosis in a cell oranimal in need thereof.

In an embodiment, the Slit protein is Slit1, 2 or 3, or a variantthereof that binds the Robo receptor and induces signaling. In oneembodiment, the Slit protein is Slit2 or Slit2-N.

In a further aspect, the present disclosure provides a pharmaceuticalcomposition comprising a Slit protein or nucleic acid and an additionalanti-fibrotic agent. In one embodiment, the Slit protein is Slit1, 2 or3, or a variant thereof that binds the Robo receptor and inducessignaling. In another embodiment, the Slit protein is Slit2 or Slit2-N.

Other features and advantages of the present disclosure will becomeapparent from the following detailed description. It should beunderstood, however, that the detailed description and the specificexamples while indicating embodiments of the disclosure are given by wayof illustration only, since various changes and modifications within thespirit and scope of the disclosure will become apparent to those skilledin the art from this detailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosure will now be described in relation to the drawings inwhich:

FIG. 1 shows treatment with N-Slit2 (active), but not C-Slit2(inactive), prevents late ischemia-reperfusion IRI-associated renaldysfunction. (A) Male C57BL/6 mice underwent unilateral left kidneyischemia-reperfusion injury, characterized by renovascular pedicleclamping for 45 min under anesthesia, followed by clamp release andreperfusion. IRI mice were randomized to receive either 2 pg N-Slit2(n=8), equimolar concentration 0.6 μg C-Slit2 (n=7), or normal saline(N/S) vehicle control (n=11). N-Slit2, C-Slit2, and N/S wereadministered via intravenous injection 1 h prior to IRI, followed bythrice weekly intra-peritoneal injections in the 2 weeks following thesurgery. A subset of mice underwent sham surgery during which kidneyswere mobilized but uninjured to serve as healthy controls. Animals werefollowed for a total of 14 days, and then sacrificed for tissue andmolecular analysis. One day prior to sacrifice, all animals underwentnephrectomy to remove the healthy right kidney. Blood was then collectedprior to sacrifice, centrifuged, and plasma collected for measurement ofrenal function. (B) Plasma creatinine. (C) Plasma urea. *p<0.05 vs. shamoperated controls. † p<0.05 vs. normal saline vehicle-treated IRIanimal.

FIG. 2 shows N-Slit2 administration attenuates kidney fibrosis inducedby ischemia-reperfusion injury (IRI). Male C57BL/6 mice underwent shamsurgery or unilateral left-sided ischemia-reperfusion injury (IRI) asdescribed in FIG. 1. IRI mice were treated either with normal saline orN-Slit2 as described in FIG. 1. Fourteen days after surgery, mice weresacrificed, and the left kidneys harvested, sectioned, and stained withpicrosirius red (PSR) to identify fibrillar collagen with red staining.Whole-section digital analysis of PSR-stained kidneys demonstrated asignificant increase in fibrillar collagen deposition in normal saline(N/S)-treated IRI mice compared with sham mice. N-Slit2 treatmentpartially attenuated this fibrotic response. 20× images were obtainedfor sham control kidneys, N/S-treated IRI kidney, and N-Slit2-treatedIRI kidney and from the images, quantitative analysis of PSR staining isshown. *p<0.05 vs. sham operated controls. † p<0.05 vs. N/Svehicle-treated IRI mice. Abbreviations: AU, arbitrary units.

FIG. 3 shows N-Slit2 treatment attenuates renal fibroblast activationpost-ischemia-reperfusion injury. Male C57BL/6 mice underwent shamsurgery or left-sided renal ischemia-reperfusion injury as described inFIG. 1. IRI mice were treated either with normal saline or N-Slit2, andkidneys harvested and prepared as described in FIG. 1. Kidney sectionswere then immunostained with an anti-a-smooth muscle actin (α-SMA)antibody followed by a horseradish peroxidase-conjugated secondaryantibody. Whole-section digital analysis of α-SMA-stained kidneysdemonstrated a significant increase in fibroblast activation in normalsaline (N/S)-treated IRI mice compared with sham mice. N-Slit2 treatmentpartially attenuated IRI-associated fibroblast activation. *p<0.05 vs.sham operated controls. † p<0.05 vs. N/S vehicle-treated IRI mice.Abbreviations: AU, arbitrary units.

FIG. 4 shows (A) renal fibroblast cells express Robo-1 and Robo-2receptors for Slit proteins. RNA was isolated from cultured NRK49F ratrenal fibroblasts, and rat brain tissue. Forty cycles of one-stepreverse transcription PCR were performed. Robo-1 and Robo-2 mRNA wasdetected in rat brain (positive control), and also in cultured rat renalfibroblasts. (B) Immunoblotting was performed using an antibodydetecting Robo-1 and lysates isolated from NRK-49F cells. Robo-1 proteinwas detected in these cells. NTC refers to a no template control.

FIG. 5 shows N-Slit2 inhibits TGF-β-induced renal fibroblast collagenproduction. Cultured NRK49F rat renal fibroblasts were serum starved inDMEM containing 0.5% bovine serum albumin (BSA) overnight, followed byincubation with [³H]-proline and stimulation with TGF-β 4 ng/mL. Fortyfour hours later, protein was acid precipitated and unincorporated[³H]-proline washed off. As collagen is highly enriched in proline aminoacid residues, the scintillation count ([³H]-proline incorporation) fromprecipitated protein is directly proportional to the amount of collagenproduced. (A) Thirty minute pre-treatment of NRK49F cells with N-Slit2induced a dose-dependent reduction in TGF-β-induced collagen production.(B) In parallel experiments, NRK49F cells were pre-treated with eitherN-Slit2 250 ng/mL or N-Slit2 250 ng/mL mixed with molar equivalentamounts of RoboN, a soluble decoy receptor for N-Slit2. Mixing ofN-Slit2 with its soluble decoy receptor blocked its inhibitory effect onTGF-β-induced fibroblast collagen production. *p<0.05 vs. unstimulatedfibroblasts. † p<0.05 vs. TGF-β-stimulated fibroblasts. ‡ p<0.05 vs.N-Slit2- and TGF-β-treated fibroblasts. Abbreviations: cpm, counts perminute.

FIG. 6 shows Slit2 inhibits development of renal fibrosis after acuteischemic kidney injury. Male C57BL/6 mice underwent sham surgery orunilateral left-sided ischemia-reperfusion injury (IRI) as described inFIG. 1. IRI mice were treated either with normal saline or N-Slit2 asdescribed in FIG. 1. Fourteen days after surgery, mice were sacrificed,and the left kidneys harvested. The ratio of the weight of the injuredkidney: body weight (KW:BW) was determined for each mouse. As expected,even at this early time post-IRI the weights of the injured kidneys wereless than those of sham-treated kidneys, likely reflecting more tubulardrop-out and interstitial fibrosis in post-ischemic kidneys. Slit2inhibited the decrease in kidney weight, restoring values back to thoseseen in sham-treated mice. Mean values±SEM from 4 mice per group.*p<0.05vs. sham. † p<0.05 vs. N/S.

FIG. 7 shows (A) Slit2 localizes primarily to endothelial cells (arrows)in healthy rat glomerulus. After 3 wks of STZ-induced diabetes, ratsdemonstrate (B) reduced glomerular Slit2 protein, (C) hyperfiltration,and (D-E) increased glomerular endothelial volume. Thrice weekly i.p.injections of 2 μg of Slit2 attenuated increases in (C) GFR and (D-E)glomerular endothelial volume. *p<0.05 vs. control. † p<0.05 vs.vehicle-treated diabetic rats.

FIG. 8 shows A bioactive N-terminal Slit2 fragment (N-Slit2) inhibitsTGF-β-induced (A-B) RhoA activation and (C) Smad2 phosphorylation, twokey pro-fibrotic signaling pathways activated by TGF-β. (D) N-Slit2treatment also inhibited TGF-β-induced collagen production (as measuredby a ³H-proline incorporation assay). N-Slit2 treatment concentrationwas 30 nM unless otherwise specified. *p<0.05 vs. control. † p<0.05 vs.TGF-β stimulation.

FIG. 9 shows (A) Male C57BL/6 mice underwent unilateral left ureteralobstruction or sham surgery. UUO mice were randomized to receive either2 μg N-Slit2 (n=12), or normal saline (N/S) vehicle control (n=11).N-Slit2 and N/S were administered via intravenous injection 1 h prior toIRI, followed by an intra-peritoneal injection 3 days following thesurgery. Animals were followed for a total of 7 days, sacrificed, andthe left kidneys stained with picrosirius red (PSR) to identifyfibrillar collagen with red staining. Whole-section digital analysis ofPSR-stained kidneys demonstrated a significant increase in fibrillarcollagen deposition in normal saline (N/S)-treated UUO mice comparedwith sham mice. N-Slit2 treatment partially attenuated this fibroticresponse. Representative 20× images and quantitative analysis. *p<0.05vs. sham controls. † p<0.05 vs. N/S vehicle-treated UUO mice.Abbreviations: AU, arbitrary units. (B) Male C57BL/6 mice underwentunilateral left kidney ischemia-reperfusion injury, characterized byrenovascular pedicle clamping for 45 min under anesthesia, followed byclamp release and reperfusion. IRI mice were randomized to receiveeither 2 μg N-Slit2 (n=8), or normal saline (N/S) vehicle control(n=11). N-Slit2 and N/S were administered via intravenous injection 1 hprior to IRI, followed by thrice weekly intra-peritoneal injections inthe 2 weeks following the surgery. A subset of mice underwent shamsurgery during which kidneys were mobilized but uninjured to serve ashealthy controls. Animals were followed for a total of 14 days, and thensacrificed for tissue and molecular analysis. Fourteen days aftersurgery, sham and IRI mice were sacrificed, and the left kidneys stainedwith picrosirius red (PSR) to identify fibrillar collagen with redstaining. Whole-section digital analysis of PSR-stained kidneysdemonstrated a significant increase in fibrillar collagen deposition innormal saline (N/S)-treated IRI mice compared with sham mice. N-Slit2treatment partially attenuated this fibrotic response. Representative20× images and quantitative analysis. *p<0.05 vs. sham controls. †p<0.05 vs. N/S vehicle-treated IRI mice. Abbreviations: AU, arbitraryunits. (C-D) One day prior to sacrifice (ie 13 days after surgery), allanimals from the experiment described in panel (B) underwent nephrectomyto remove the healthy right kidney. Blood was then collected prior tosacrifice, centrifuged, and plasma collected for measurement of renalfunction. (C) Plasma creatinine. (D) Plasma urea. *p<0.05 vs. shamoperated controls. † p<0.05 vs. normal saline vehicle-treated IRIanimal.

DETAILED DESCRIPTION

The present inventors have demonstrated that Slit2, which was previouslyknown to inhibit platelet coagulation and acute kidney injury, alsoinhibits fibrosis and improves renal function in a model of chronickidney disease. The present inventors have further shown that the Robo-1receptor, to which Slit proteins bind, is expressed by fibroblasts.

Accordingly, in one aspect, the present disclosure provides a method ofinhibiting fibrosis comprising administering a Slit protein or nucleicacid to a cell or animal in need thereof. Also provided is use of a Slitprotein or nucleic acid for inhibiting fibrosis in a cell or animal inneed thereof. Further provided is use of a Slit protein or nucleic acidin the manufacture of a medicament for inhibiting fibrosis in a cell oranimal in need thereof. Also provided is a Slit protein or nucleic acidfor use in inhibiting fibrosis in a cell or animal in need thereof.

The phrase “inhibiting fibrosis” as used herein refers to preventing orreducing extracellular matrix fibers from accumulating in tissue.

The term “extracellular matrix” as used herein refers to fibers that aretypically secreted from a cell that reside in the extracellular spaceand include without limitation, collagen and fibronectin.

Inhibiting fibrosis as used herein refers to a decrease of at least 5%,10%, 20%, 30%, 40%, 50%, 60%, 70%, 80% or more of extracellular matrixaccumulation compared to an untreated control or reference value. In oneembodiment, the extracellular matrix accumulation is characterized bycollagen deposition and/or increased collagen synthesis and inhibitionof extracellular matrix accumulation is due to a decrease in collagendeposition and/or synthesis.

In some embodiments, inhibiting fibrosis is useful in treating a varietyof diseases and conditions, including without limitation, kidneyfibrosis, lung fibrosis, cardiac fibrosis, liver fibrosis, or excessivefibrosis deposited due to a wound. In a particular embodiment, thefibrosis is kidney fibrosis.

Accordingly, the present disclosure provides a method of treating afibrotic-related disorder, condition or disease comprising administeringa Slit protein or nucleic acid to a cell or animal in need thereof. Alsoprovided is use of a Slit protein or nucleic acid for treating afibrotic-related disorder, condition or disease in a cell or animal inneed thereof. Further provided is use of a Slit protein or nucleic acidin the manufacture of a medicament for treating a fibrotic-relateddisorder, condition or disease in a cell or animal in need thereof. Alsoprovided is a Slit protein or nucleic acid for use in treating afibrotic-related disorder, condition or disease in a cell or animal inneed thereof.

The term “fibrotic disorder, condition or disease” as used herein refersto a disorder, condition or disease that results in increased fibrosisand scarring, typically, over an extended period of time, and includeswithout limitation, glomerulonephritis, diabetic nephropathy, lupusnephritis, toxic nephropathy, chronic pyelonephritis, polycystic kidneydisease, renal scarring, wound scarring, post-cardiac infarction, cysticfibrosis, idiopathic pulmonary fibrosis, cirrhosis, chronic obstructivepulmonary disease, cardiomyopathy, and all other progressive diseasesmarked by fibrosis. In a particular embodiment, the fibrotic disorder,condition or disease is diabetic nephropathy.

In some embodiments of the methods and uses disclosed herein, the Slitprotein or nucleic acid is administered or used locally. In someembodiments, the Slit protein or nucleic acid is administered or usedchronically or long-term, for a period ranging from weeks to years. Insome embodiments, the Slit protein or nucleic acid is administereddaily, weekly or monthly.

In one embodiment, the present disclosure provides a method of treatingchronic kidney disease comprising administering a Slit protein ornucleic acid to a cell or animal in need thereof. Also provided is useof a Slit protein or nucleic acid for treating chronic kidney disease ina cell or animal in need thereof. Further provided is use of a Slitprotein or nucleic acid in the manufacture of a medicament for treatingchronic kidney disease in a cell or animal in need thereof. Alsoprovided is a Slit protein or nucleic acid for use in treating chronickidney disease in a cell or animal in need thereof.

The term “chronic kidney disease” as used herein refers to theprogressive loss of kidney function over a period of months or years. Inone embodiment, the kidney disease follows from an acute kidney injury.

In an embodiment, the subject with chronic kidney disease has aglomerular filtration rate of less than 60 ml/min/1.73 m². In anotherembodiment, the subject with chronic kidney disease is at stage 3 orgreater CKD.

A person skilled in the art would understand that chronic kidney diseaserefers to a chronic progressive loss of function over weeks, months oryears after an initial injury or onset of disorder. In contrast, acutekidney injury is short-term and is marked by influx of neutrophils, Tlymphocytes, and monocytes/macrophages into the kidney within the first48 hours post-injury.

Accordingly, in one embodiment, the Slit protein or nucleic acid isadministered 5 days after acute kidney injury, or later. In anotherembodiment, the Slit protein or nucleic acid is administered 10 daysafter acute kidney injury, or later. In yet another embodiment, the Slitprotein or nucleic acid is administered or used 14 days, 1 month, or 6months after acute kidney injury, or later.

In other embodiments, the present disclosure provides methods and usesfor inhibiting fibrosis comprising prophylactically treating a subjectat risk for fibrosis, including without limitation, subjects withpost-acute kidney injury, diabetes, chronic glomerulonephritis, lupusnephritis, toxic nephropathy, chronic pyelonephritis, polycystic kidneydisease, renal scarring, wound scarring, post-cardiac infarction, cysticfibrosis, idiopathic pulmonary fibrosis, cirrhosis, chronic obstructivepulmonary disease, cardiomyopathy, and all other progressive diseasesmarked by fibrosis.

Accordingly, the present disclosure also provides a method ofprophylactically treating a subject at risk of fibrosis comprisingadministering a Slit protein or nucleic acid encoding a Slit protein toa cell or animal in need thereof. Also provided is use of a Slit proteinor nucleic acid for prophylactically treating a subject at risk offibrosis in a cell or animal in need thereof. Further provided is use ofa Slit protein or nucleic acid in the manufacture of a medicament forprophylactically treating a subject at risk of fibrosis in a cell oranimal in need thereof. Also provided is a Slit protein or nucleic acidfor use in prophylactically treating a subject at risk of fibrosis in acell or animal in need thereof.

In one embodiment, the present disclosure provides a method ofprophylactically treating a subject at risk of fibrosis comprisinginstilling a Slit protein or nucleic acid encoding a Slit proteinlocally, via an indwelling catheter, or systemically. Also provided isuse of a Slit protein or nucleic acid encoding a Slit protein forinstillation locally, via an indwelling catheter, or systemically, totreat a subject at risk of fibrosis. Further provided is use of a Slitprotein or nucleic acid encoding a Slit protein in the preparation of amedicament for instillation locally, via an indwelling catheter, orsystemically, in a subject at risk of fibrosis. Also provided is a Slitprotein or nucleic acid encoding a Slit protein for use in instillationlocally, via an indwelling catheter, or systemically, in a subject atrisk of fibrosis.

The phrase “prophylactically treating a subject at risk of fibrosis”refers to treating a subject that has had an injury that typicallyresults in scarring or fibrosis prior to any evidence of scarring orfibrosis. In an embodiment, the subject is prophylactically treatedchronically, for example, for more than 5 days, more than 10 days, morethan two weeks, more than 1 month after initial injury.

The term “treatment or treating” as used herein means an approach forobtaining beneficial or desired results, including clinical results.Beneficial or desired clinical results can include, but are not limitedto, alleviation or amelioration of one or more symptoms or conditions,diminishment of extent of disease, stabilized (i.e. not worsening) stateof disease, preventing spread of disease, delay or slowing of diseaseprogression, amelioration or palliation of the disease state, andremission (whether partial or total), whether detectable orundetectable.

The term “a cell” as used herein includes a plurality of cells andrefers to all types of cells. Administering a compound to a cellincludes in vivo, ex vivo and in vitro treatment.

The term “animal” or “subject” as used herein includes all members ofthe animal kingdom, optionally mammal. The term “mammal” as used hereinis meant to encompass, without limitation, humans, domestic animals suchas dogs, cats, horses, cattle, swine, sheep, goats, and the like, aswell as wild animals. In an embodiment, the mammal is human.

The term “effective amount” as used herein means a quantity sufficientto, when administered to an animal, effect beneficial or desiredresults, including clinical results, and as such, an “effective amount”depends upon the context in which it is being applied. For example, inthe context of inhibiting platelet coagulation, it is the amount of thea Slit protein or nucleic acid sufficient to achieve such an inhibitionas compared to the response obtained without administration of the aSlit protein or nucleic acid.

The term “Slit protein” as used herein is intended to refer to any oneof a family of proteins known to be ligands for the Roundabout receptor(Robo), including Slit1, Slit2 and Slit3. The term “Slit” is intended toencompass the protein from any species or source, optionally, human Slitproteins. The term “Slit nucleic acid” is intended to encompass anucleic acid encoding a Slit protein. The nucleic acid and proteinsequences of human Slit1 are set forth as NM_003061 and NP_003052,respectively. The nucleic acid and protein sequences of human Slit2 areset forth as AF133270.1 and AAD25539, respectively. The nucleic acid andprotein sequences of human Slit3 are set forth as NM_003062.2 andNP_003053.1, respectively. Slit sequences as set forth are incorporatedby reference in their entirety.

In an embodiment, the Slit protein is Slit1, 2 or 3 or a variantthereof. In another embodiment, the Slit protein is Slit2 or Slit2-N ora variant thereof.

The term “Slit2-N” or “N-Slit2” as used herein refers to a truncatedSlit2 protein comprising the N-terminal which contains the leucine richregion necessary for binding to the Robo-1 receptor and for downstreamsignal transduction.

The term “nucleic acid molecule” is intended to include unmodified DNAor RNA or modified DNA or RNA. For example, the nucleic acid moleculesor polynucleotides of the disclosure can be composed of single- anddouble stranded DNA, DNA that is a mixture of single- anddouble-stranded regions, single- and double-stranded RNA, and RNA thatis a mixture of single- and double-stranded regions, hybrid moleculescomprising DNA and RNA that may be single-stranded or, more typicallydouble-stranded or a mixture of single- and double-stranded regions. Inaddition, the nucleic acid molecules can be composed of triple-strandedregions comprising RNA or DNA or both RNA and DNA. The nucleic acidmolecules of the disclosure may also contain one or more modified basesor DNA or RNA backbones modified for stability or for other reasons.“Modified” bases include, for example, tritiated bases and unusual basessuch as inosine. A variety of modifications can be made to DNA and RNA;thus “nucleic acid molecule” embraces chemically, enzymatically, ormetabolically modified forms. The term “polynucleotide” shall have acorresponding meaning.

The term “variant” as used herein includes modifications, substitutions,additions, derivatives, analogs, fragments or chemical equivalents ofthe Slit nucleic acid or amino acid sequences disclosed herein thatperform substantially the same function in substantially the same way.For instance, the variants of the Slit peptides would have the samefunction, for example, of binding the Robo receptor, inducing signalingor inhibiting fibrosis.

Variants also include peptides with amino acid sequences that aresubstantially or essentially identical to the amino acid sequences ofthe Slit protein or nucleic acid molecules with nucleic acid sequencethat are substantially or essentially identical to the nucleic acidsequence encoding the Slit proteins.

The term “substantially identical” or “essentially identical” as usedherein means an amino acid sequence that, when optimally aligned, forexample using the methods described herein, share at least 75%, 80%,85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% sequence identity with asecond amino acid sequence.

The term “sequence identity” as used herein refers to the percentage ofsequence identity between two polypeptide and/or nucleotide sequences.

To determine the percent identity of two amino acid sequences, thesequences are aligned for optimal comparison purposes (e.g., gaps can beintroduced in the sequence of a first amino acid or nucleic acidsequence for optimal alignment with a second amino acid or nucleic acidsequence). The amino acid residues at corresponding amino acid positionsare then compared. When a position in the first sequence is occupied bythe same amino acid residue or nucleotide as the corresponding positionin the second sequence, then the molecules are identical at thatposition. The percent identity between the two sequences is a functionof the number of identical positions shared by the sequences (i.e., %identity=number of identical overlapping positions/total number ofpositions.times.100%). In one embodiment, the two sequences are the samelength. The determination of percent identity between two sequences canalso be accomplished using a mathematical algorithm. A preferred,non-limiting example of a mathematical algorithm utilized for thecomparison of two sequences is the algorithm of Karlin and Altschul,1990, Proc. Natl. Acad. Sci. U.S.A. 87:2264-2268, modified as in Karlinand Altschul, 1993, Proc. Natl. Acad. Sci. U.S.A. 90:5873-5877. Such analgorithm is incorporated into the NBLAST and XBLAST programs ofAltschul et al., 1990, J. Mol. Biol. 215:403. BLAST nucleotide searchescan be performed with the NBLAST nucleotide program parameters set,e.g., for score=100, wordlength=12 to obtain nucleotide sequenceshomologous to a nucleic acid molecule of the present disclosure. BLASTprotein searches can be performed with the XBLAST program parametersset, e.g., to score-50, wordlength=3 to obtain amino acid sequenceshomologous to a protein molecule of the present disclosure. To obtaingapped alignments for comparison purposes, Gapped BLAST can be utilizedas described in Altschul et al., 1997, Nucleic Acids Res. 25:3389-3402.Alternatively, PSI-BLAST can be used to perform an iterated search whichdetects distant relationships between molecules (Id.). When utilizingBLAST, Gapped BLAST, and PSI-Blast programs, the default parameters ofthe respective programs (e.g., of XBLAST and NBLAST) can be used (see,e.g., the NCBI website). Another non-limiting example of a mathematicalalgorithm utilized for the comparison of sequences is the algorithm ofMyers and Miller, 1988, CABIOS 4:11-17. Such an algorithm isincorporated in the ALIGN program (version 2.0) which is part of the GCGsequence alignment software package. When utilizing the ALIGN programfor comparing amino acid sequences, a PAM120 weight residue table, a gaplength penalty of 12, and a gap penalty of 4 can be used. The percentidentity between two sequences can be determined using techniquessimilar to those described above, with or without allowing gaps. Incalculating percent identity, typically only exact matches are counted.

In other embodiments, to determine the percentage of identity betweentwo polypeptide sequences, the amino acid sequences of such twosequences are aligned, for example using the Clustal W algorithm(Thompson, J D, Higgins D G, Gibson T J, 1994, Nucleic Acids Res.22(22):4673-4680.), together with BLOSUM 62 scoring matrix (Henikoff S.and Henikoff J. G., 1992, Proc. Natl. Acad. Sci. USA 89: 10915-10919.)and a gap opening penalty of 10 and gap extension penalty of 0.1, sothat the highest order match is obtained between two sequences whereinat least 50% of the total length of one of the sequences is involved inthe alignment.

Other methods that may be used to align sequences are the alignmentmethod of Needleman and Wunsch (Needleman and Wunsch. J. Mol. Biol.,1970, 48:443), as revised by Smith and Waterman (Smith and Waterman.Adv. Appl. Math. 1981, 2:482) so that the highest order match isobtained between the two sequences and the number of identical aminoacids is determined between the two sequences. Other methods tocalculate the percentage identity between two amino acid sequences aregenerally art recognized and include, for example, those described byCarillo and Lipton

(Carillo and Lipton SIAM J. Applied Math. 1988, 48:1073) and thosedescribed in Computational Molecular Biology (Computational MolecularBiology, Lesk, e.d. Oxford University Press, New York, 1988,Biocomputing: Informatics and Genomics Projects). Generally, computerprograms will be employed for such calculations.

The term “analog” means an amino acid or nucleic acid sequence which hasbeen modified as compared to the Slit sequences wherein the modificationdoes not alter the utility of the sequence (e.g. binding to Robo) asdescribed herein. The modified sequence or analog may have improvedproperties over the Slit sequences. One example of a nucleic acidmodification to prepare an analog is to replace one of the naturallyoccurring bases (i.e. adenine, guanine, cytosine or thymidine) of thesequence with a modified base such as xanthine, hypoxanthine,2-aminoadenine, 6-methyl, 2-propyl and other alkyl adenines, 5-halouracil, 5-halo cytosine, 6-aza uracil, 6-aza cytosine and 6-aza thymine,pseudo uracil, 4-thiouracil, 8-halo adenine, 8-aminoadenine, 8-thioladenine, 8-thiolalkyl adenines, 8-hydroxyl adenine and other8-substituted adenines, 8-halo guanines, 8 amino guanine, 8-thiolguanine, 8-thiolalkyl guanines, 8-hydroxyl guanine and other8-substituted guanines, other aza and deaza uracils, thymidines,cytosines, adenines, or guanines, 5-trifluoromethyl uracil and5-trifluoro cytosine.

Another example of a modification is to include modified phosphorous oroxygen heteroatoms in the phosphate backbone, short chain alkyl orcycloalkyl intersugar linkages or short chain heteroatomic orheterocyclic intersugar linkages in the nucleic acid molecules. Forexample, the nucleic acid sequences may contain phosphorothioates,phosphotriesters, methyl phosphonates, and phosphorodithioates.

A further example of an analog of a nucleic acid molecule of thedisclosure is a peptide nucleic acid (PNA) wherein the deoxyribose (orribose) phosphate backbone in the DNA (or RNA), is replaced with apolyamide backbone which is similar to that found in peptides (P. E.Nielsen, et al Science 1991, 254, 1497). PNA analogs have been shown tobe resistant to degradation by enzymes and to have extended lives invivo and in vitro. PNAs also bind stronger to a complementary DNAsequence due to the lack of charge repulsion between the PNA strand andthe DNA strand. Other nucleic acid analogs may contain nucleotidescontaining polymer backbones, cyclic backbones, or acyclic backbones.For example, the nucleotides may have morpholino backbone structures(U.S. Pat. No. 5,034,506). The analogs may also contain groups such asreporter groups, a group for improving the pharmacokinetic orpharmacodynamic properties of nucleic acid sequence.

Slit protein may be modified to contain amino acid substitutions,insertions and/or deletions that do not alter the binding and/oractivating properties of the protein. Conserved amino acid substitutionsinvolve replacing one or more amino acids of the protein with aminoacids of similar charge, size, and/or hydrophobicity characteristics.When only conserved substitutions are made the resulting analog shouldbe functionally equivalent to Slit. Non-conserved substitutions involvereplacing one or more amino acids of the conjugate protein with one ormore amino acids which possess dissimilar charge, size, and/orhydrophobicity characteristics.

The disclosure further encompasses nucleic acid molecules that differfrom any of the nucleic acid molecules disclosed herein in codonsequences due to the degeneracy of the genetic code.

Administration or use of a nucleic acid encoding Slit protein or variantthereof includes administration or use of a vector containing thenucleic acid molecule and the necessary regulatory sequences for thetranscription and translation of the inserted sequence.

Suitable regulatory sequences may be derived from a variety of sources,including bacterial, fungal, viral, mammalian, or insect genes (forexample, see the regulatory sequences described in Goeddel, GeneExpression Technology: Methods in Enzymology 185, Academic Press, SanDiego, Calif. (1990)). Selection of appropriate regulatory sequences isdependent on the host cell chosen as discussed below, and may be readilyaccomplished by one of ordinary skill in the art. Examples of suchregulatory sequences include: a transcriptional promoter and enhancer orRNA polymerase binding sequence, a ribosomal binding sequence, includinga translation initiation signal. Additionally, depending on the hostcell chosen and the vector employed, other sequences, such as an originof replication, additional DNA restriction sites, enhancers, andsequences conferring inducibility of transcription may be incorporatedinto the expression vector. It will also be appreciated that thenecessary regulatory sequences may be supplied by Slit sequences and/orits flanking regions.

Recombinant expression vectors can be introduced into host cells toproduce a transformed host cell. The term “transformed host cell” isintended to include cells that are capable of being transformed ortransfected with a recombinant expression vector of the disclosure. Theterms “transduced”, “transformed with”, “transfected with”,“transformation” and “transfection” are intended to encompassintroduction of nucleic acid (e.g. a vector or naked RNA or DNA) into acell by one of many possible techniques known in the art. Prokaryoticcells can be transformed with nucleic acid by, for example,electroporation or calcium-chloride mediated transformation. Forexample, nucleic acid can be introduced into mammalian cells viaconventional techniques such as calcium phosphate or calcium chlorideco-precipitation, DEAE-dextran mediated transfection, lipofectin,electroporation, microinjection, RNA transfer, DNA transfer, artificialchromosomes, viral vectors and any emerging gene transfer technologies.Suitable methods for transforming and transfecting host cells can befound in Sambrook et al. (Molecular Cloning: A Laboratory Manual, 2ndEdition, Cold Spring Harbor Laboratory press (1989)), and otherlaboratory textbooks.

Suitable expression vectors for directing expression in mammalian cellsgenerally include a promoter (e.g., derived from viral material such aspolyoma, Adenovirus 2, cytomegalovirus and Simian Virus 40), as well asother transcriptional and translational control sequences. Examples ofmammalian expression vectors include pCDM8 (Seed, B., Nature 329:840(1987)), pMT2PC (Kaufman et al., EMBO J. 6:187-195 (1987)) and pCMV(Clontech, Calif., U.S.A.).

In an embodiment, the methods and uses further comprise administrationor use of another anti-fibrotic agent in combination with the Slitprotein or nucleic acid. Other anti-fibrotic agents include, withoutlimitation, ACE inhibitors and anti-TGF-β agents including, withoutlimitation, antibodies.

The methods and uses described herein include administration or use ofthe Slit protein or nucleic acid alone or as part of a pharmaceuticalcomposition comprising the Slit protein.

The pharmaceutical compositions can be prepared by per se known methodsfor the preparation of pharmaceutically acceptable compositions whichcan be administered to patients, and such that an effective quantity ofthe active substance is combined in a mixture with a pharmaceuticallyacceptable vehicle. Suitable vehicles are described, for example, inRemington's Pharmaceutical Sciences (Remington's PharmaceuticalSciences, Mack Publishing Company, Easton, Pa., USA 2003-20^(th)Edition) and in The United States Pharmacopeia: The National Formulary(USP 24 NF19) published in 1999).

On this basis, the pharmaceutical compositions for use in the methodsand/or uses described herein include, albeit not exclusively, the activecompound or substance in association with one or more pharmaceuticallyacceptable vehicles or diluents, and contained in buffered solutionswith a suitable pH and iso-osmotic with the physiological fluids.

The pharmaceutical compositions may additionally contain other agentssuch as other anti-fibrotic agents. Accordingly, in another embodiment,the present disclosure provides a pharmaceutical composition comprisinga Slit protein or nucleic acid and an additional anti-fibrotic agent.Other anti-fibrotic agents include, without limitation, ACE inhibitorsand anti-TGF-β agents including, without limitation, antibodies.

The above disclosure generally describes the present application. A morecomplete understanding can be obtained by reference to the followingspecific examples. These examples are described solely for the purposeof illustration and are not intended to limit the scope of thedisclosure. Changes in form and substitution of equivalents arecontemplated as circumstances might suggest or render expedient.Although specific terms have been employed herein, such terms areintended in a descriptive sense and not for purposes of limitation.

The following non-limiting examples are illustrative of the presentdisclosure:

EXAMPLES Example 1

To study the effects of Slit2 on development of long-term fibrosis afteracute kidney injury, a mouse model of unilateral kidney IRI wasestablished (Furuichi et al., 2006; Feitoza et al., 2008; Ko et al.,2010). Clamping of one, rather than both, renal pedicle(s) permitsprolonged survival of experimental mice and thus allows evaluation oflate fibrosis and renal function (Furuichi et al., 2006; Feitoza et al.,2008; Ko et al., 2010). The left renal pedicle is cross-clamped for 45min (Furuichi et al., 2006; Feitoza et al., 2008; Ko et al., 2010). Uponrelease of the clamp, the kidney is observed to ensure that reperfusionoccurs. Sham surgery is similarly performed, without cross-clamping therenal vessels. A prolonged period of ischemia (ie 45 min) at the outsetis needed to produce sufficient injury to cause late interstitialfibrosis (Furuichi et al., 2006; Feitoza et al., 2008; Ko et al., 2010).If both kidneys were subjected to this degree of ischemic injury, themice would succumb early on to acute renal failure, and could not beused to study late events (Furuichi et al., 2006; Feitoza et al., 2008;Ko et al., 2010). In this model, early fibrotic changes are visible by14 days and more robust fibrosis is evident at 28 days after inductionof acute ischemia (Furuichi et al., 2006; Feitoza et al., 2008; Ko etal., 2010). In preliminary experiments, mice were subjected to renalartery clamping and release, or to sham surgery, of only the left kidney(Furuichi et al., 2006; Feitoza et al., 2008; Ko et al., 2010). Asignificant increase in renal fibrosis was seen even at 14 days.

Slit2 or control vehicle was injected intravenously 1 hour prior toinducing IRI and intraperitoneally (ip) every 3 d thereafter. To studythe function of the injured kidney, the uninjured kidney was resected onDay 13. The injured kidney and blood were collected 1 d later, that is,14 d after IRI (Furuichi et al., 2006; Feitoza et al., 2008; Ko et al.,2010).

Mice underwent nephrectomy of the uninjured kidney 1 d prior tomeasurement of renal function, so that the plasma creatinine and ureareflect the function of the injured kidney, and not that of theuninjured kidney (Furuichi et al., 2006; Ko et al., 2010). Even at thisearly time, mice that received vehicle control had lower kidney weightsthan their sham-operated counterparts, reflecting loss of normal kidneytissue and development of more fibrosis (FIG. 6). Slit2 treatmentresulted in significantly higher KW:BW, suggesting less fibrosis, evenearly after kidney IRI. At longer time points (28 d), this effect wouldbe expected to be greatly pronounced. Plasma creatinine and ureaconcentration were measured using standard autoanalyzer methods (FIG.1).

To assess fibrosis, the injured kidney was sectioned and stained withpicrosirius red (PSR) to identify fibrillar collagen with red staining.(FIG. 2).

Mice that received Slit2 had preserved kidney weight, less renalfibrosis and better renal function than mice treated with vehiclecontrol (FIGS. 1, 2, and 6). These studies suggest that administrationof Slit2 can prevent long-term renal fibrosis after AKI.

To determine whether Slit2-treated mice exhibit less myofibroblastinfiltration in the renal interstitium, immunostaining was done using Abthat detects α-smooth muscle actin (α-SMA), a mesenchymal markerabundantly expressed by myofibroblasts (FIG. 3). The amount of renalcortex and medulla occupied by α-SMA was determined (FIG. 3) (Furuichiet al., 2006; Feitoza et al., 2008).

To determine whether Slit2 could directly act on fibroblasts, RT-PCR wasperformed on RNA isolated from NRK-49F renal fibroblasts and it wasconfirmed that these cells express both Robo-1 and Robo-2 (FIG. 4).Robo-1 expression in cultured NRK49F rat renal fibroblasts was alsodetected by immunoblotting (FIG. 4) and immunostaining with ananti-Robo-1 antibody.

Slit2 specifically decreased ³H-proline incorporation in TGF-β-treatedNRK49F rat renal fibroblasts, suggesting a decrease in collagensynthesis (FIG. 5) (Furuichi et al., 2006; Yuen et al., 2010). Theseresults indicate that Slit2 may directly act on renal fibroblasts toinhibit their secretion of collagenous matrix, a key element of theprogressive fibrosis that follows AKI.

Example 2 Slit2 Regulates Glomerular Angiogenesis and Hyperfiltration inDiabetes

Building upon data describing Slit2-Robo4 signaling as ananti-angiogenic regulatory pathway [Jones et al. 2008; Jones et al.2009; Marlow et al. 2010], it was recently discovered that glomerularendothelium expresses both Slit2 and Robo4, and that glomerular Slit2 isdownregulated following the onset of experimental diabetes, a changethat coincides with glomerular neovascularization and hyperfiltration(FIG. 7). Illustrating the importance of Slit2 as an inhibitor ofpathologic diabetic endothelial injury, i.p. injections of Slit2abrogated streptozotocin (STZ)-induced glomerular capillary growth andhyperfiltration (FIG. 7). Given the link between hyperfiltration andpoor long-term kidney outcomes, the data suggests the potential forSlit2 as a therapy to arrest progression of early diabetic nephropathyby targeting diabetes-induced neovascularization.

Example 3 Slit2 is a Potent Anti-Fibrotic TGF-b-Inhibitory Agent inNRK49F Rat Renal Fibroblasts

As fibroblast activation is dependent on actin rearrangements [Hubchaket al. 2003], whether Slit2 might regulate renal fibrogenesis was alsoexamined. It was first demonstrated that both mesangial cells and renalfibroblasts express the Slit2 receptor Robo1. Next, it was found thatSlit2 inhibits TGF-β-induced fibroblast RhoA activation and Smad2phosphorylation, two key pro-fibrotic pathways activated by TGF-β (FIG.8). Not surprisingly, Slit2 inhibited TGF-β-induced fibroblast collagenproduction (FIG. 8).

Example 4 Slit2 Inhibits Renal Fibrosis in Two Independent Mouse Modelsof Chronic Kidney Disease

Slit2 administration blocked renal fibrogenesis in two independent mousemodels of kidney fibrosis, leading to improvements in renal function(FIG. 9). This new and previously undescribed anti-fibrotic activitysuggests that in addition to targeting the glomerular neovascularizationthat characterizes early disease, Slit2 may also be useful for theprevention of fibrosis in more advanced diabetic nephropathy.

While the present disclosure has been described with reference to whatare presently considered to be the examples, it is to be understood thatthe disclosure is not limited to the disclosed examples. To thecontrary, the disclosure is intended to cover various modifications andequivalent arrangements included within the spirit and scope of theappended claims.

All publications, patents and patent applications are hereinincorporated by reference in their entirety to the same extent as ifeach individual publication, patent or patent application wasspecifically and individually indicated to be incorporated by referencein its entirety.

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1. A method of inhibiting fibrosis comprising administering a Slitprotein or nucleic acid to a cell or animal in need thereof.
 2. Themethod of claim 1, wherein the fibrosis is due to increased collagendeposition and/or synthesis.
 3. The method of claim 1, wherein thefibrosis is kidney fibrosis, lung fibrosis, cardiac fibrosis, liverfibrosis or fibrosis deposited due to a wound.
 4. A method of treating afibrotic-related disorder condition or disease or a risk of a fibrosiscomprising administering a Slit protein or nucleic acid to a cell oranimal in need thereof.
 5. The method of claim 4, wherein thefibrotic-related disorder, condition or disease is glomerulonephritis,diabetic nephropathy, lupus nephritis, toxic nephropathy, chronicpyelonephritis, polycystic kidney disease, renal scarring, woundscarring, post-cardiac infarction, cystic fibrosis, idiopathic pulmonaryfibrosis, cirrhosis, chronic obstructive pulmonary disease,cardiomyopathy, and all other progressive diseases marked by fibrosis.6. The use method of claim 4, wherein the fibrotic-related disorder,condition or disease is chronic kidney disease.
 7. The method of claim6, wherein the Slit2 protein or nucleic acid is used 5 days after acutekidney injury, or later.
 8. The method of claim 7, wherein the Slit2protein or nucleic acid is used 10 days after acute kidney injury, orlater.
 9. The method of claim 6, wherein the subject with chronic kidneydisease has a glomerular filtration rate of less than 60 ml/min/1.73 m².10. The method of claim 6, wherein the subject with chronic kidneydisease is at stage 3 or greater.
 11. The method of claim 4, wherein thefibrotic disorder, condition or disease is diabetic nephropathy. 12.(canceled)
 13. The method of claim 1, wherein the Slit protein ornucleic acid is suitable for daily, weekly or monthly use. 14.(canceled)
 15. (canceled)
 16. The method of claim 1, wherein the Slitprotein or nucleic acid is suitable for local administration.
 17. Themethod of claim 1, wherein the Slit protein or nucleic acid is suitablefor long-term use.
 18. The method of claim 1, wherein the Slit proteinis Slit1, 2 or 3, or a variant thereof that binds the lobo receptor andinduces signaling.
 19. The method of claim 18, wherein the Silt proteinis Slit2 or Slit2-N.
 20. A pharmaceutical composition comprising a Slitprotein or nucleic acid and an additional anti-fibrotic agent.
 21. Thepharmaceutical composition of claim 20, wherein the Slit protein isSlit1, 2 or 3, or a variant thereof that binds the Robo receptor andinduces signaling.
 22. The pharmaceutical composition of claim 21,wherein the Slit protein is Slit2 or Slit2-N.